Dementia and suicidal behavior: a review of the literature

Haw, Camilla; Harwood, Daniel; Hawton, Keith

doi:10.1017/s1041610209009065

Cited by 148 publications

(150 citation statements)

References 125 publications

(155 reference statements)

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“…In a recent review of suicide in dementia, preserved insight was a putative risk factor. 27 Participants in the PREDICT-HD Study are not informed of the HD diagnosis/phenoconversion by the research team, but some with more symptoms may have been given a formal diagnosis of HD onset by their treating HD specialist. Because group D had slightly more progression of HD, more symptoms would be expected, but group B although undiagnosed was symptomatic as well.…”

Section: Resultsmentioning

confidence: 99%

Unawareness of motor phenoconversion in Huntington disease

McCusker¹,

Gunn

Epping

et al. 2013

Neurology

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Objective: To determine whether Huntington disease (HD) mutation carriers have motor symptoms (complaints) when definite motor onset (motor phenoconversion) is diagnosed and document differences between the groups with and without unawareness of motor signs. Methods:We analyzed data from 550 HD mutation carriers participating in the multicenter PREDICT-HD Study followed through the HD prodrome. Data analysis included demographics, the Unified Huntington's Disease Rating Scale (UHDRS) and the Participant HD History of symptoms, selfreport of progression, and cognitive, behavioral, and imaging measures. Unawareness was identified when no motor symptoms were self-reported but when definite motor HD was diagnosed.Results: Of 38 (6.91%) with onset of motor HD, almost half (18/38 5 47.36%) had no motor symptoms despite signs of disease on the UHDRS motor rating and consistent with unawareness. A group with motor symptoms and signs was similar on a range of measures to the unaware group. Those with unawareness of HD signs reported less depression. Patients with symptoms had more striatal atrophy on imaging measures.

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Section: Resultsmentioning

confidence: 99%

Unawareness of motor phenoconversion in Huntington disease

McCusker¹,

Gunn

Epping

et al. 2013

Neurology

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“…While dementia in general is not a strong risk factor for late-life suicide (36), these observations raise the possibility that for a subgroup, the interval of increased risk for suicidal behavior may be at its prodromal or early stage (37). This study is not designed to specifically investigate suicide risk in elderly with cognitive impairment, because we excluded subjects diagnosed with dementia.…”

Section: Discussionmentioning

confidence: 99%

Impaired Executive Function in Contemplated and Attempted Suicide in Late Life

Gujral

Dombrovski

Butters

et al. 2014

The American Journal of Geriatric Psychiatry

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Objective Executive deficits may play an important role in late-life suicide. Yet, current evidence in this area is inconclusive and does not indicate whether these deficits are broadly associated with suicidal ideation or specific to suicidal behavior. This study examined global cognition and specifically executive function impairments as correlates of suicidal ideation and suicidal behavior in depressed older adults, with the goal of extending an earlier preliminary study. Design Case-control study. Setting University-affiliated psychiatric hospital. Participants All were aged 60+: 83 depressed suicide attempters, 43 depressed individuals having suicidal ideation with a specific plan, 54 non-suicidal depressed participants, and 48 older adults with no history of psychiatric disorders. Measurements Global cognitive function - Dementia Rating Scale (DRS), Executive function - Executive Interview (EXIT). Results Both suicide attempters and suicide ideators performed worse than the two comparison groups on the EXIT, with no difference between suicide attempters and suicide ideators. On the DRS total score, as well as on Memory and Attention subscales, suicide attempters and ideators and non-suicidal depressed subjects performed similarly and were impaired relative to with non-psychiatric control subjects. Controlling for education, substance use disorders, and medication exposure did not affect group differences in performance on either the EXIT or DRS. Conclusions Executive deficits, captured with a brief instrument, are associated broadly with suicidal ideation in older depressed adults but do not appear to directly facilitate suicidal behavior. Our data are consistent with the idea that different vulnerabilities may operate at different stages in the suicidal process.

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“…In those studies which did not provide data to calculate the proportions of death due to suicide or any direct calculation of rate, some [18,19] , but not all [20] , studies suggested an association between suicide and HD. The higher risk of suicide observed in HD has not been demonstrated for other dementias, for which most evidence suggests a lower rate of suicide compared to the general population [21] .…”

Section: Introductionmentioning

confidence: 88%

Suicidal Behavior in Prodromal Huntington Disease

Fiedorowicz

Mills²,

Ruggle³

et al. 2011

Neurodegener Dis

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Background: Several studies have suggested a greater risk of suicide in Huntington disease (HD); however, unique risk factors for suicide in HD are not established. Objective: We sought to determine risk factors for suicidal behavior, defined as suicide or attempted suicide, in prodromal HD. Methods: From the prospective PREDICT-HD cohort, we identified 735 cases with HD gene expansion but no manifest symptoms of HD and 194 non-gene-expanded controls. In survival analysis, a number of potential risk factors for suicidal behavior were assessed, including symptoms of depression, hopelessness, substance abuse, marital status, gender, and psychiatric history. Results: During a mean of 3.7 years of prospective follow-up, 12 cases (1.6%) attempted suicide and 1 completed suicide (0.1%). No suicides were observed among controls. In univariate Cox proportional hazards regression models, a history of suicide attempts (HR 8.5, 95% CI 2.8–26.1, p < 0.0002) and a Beck Depression Inventory II score >13 (HR 7.2, 95% CI 2.3–22.0, p < 0.0006) were associated with suicidal behavior. These risk factors had independent effects in multivariate models. A history of incarceration in the past 2 years was also associated (HR 12.5, 95% CI 2.7–56.6, p < 0.002), though uncommon. No further risk factors were identified. Conclusion: A history of suicide attempts and the presence of depression are strongly predictive of suicidal behavior in prodromal HD. As these risk factors are among the most robust risk factors for suicide, established suicide risk factors appear applicable to those with prodromal HD.

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Dementia and suicidal behavior: a review of the literature

Abstract: Further research should be undertaken to examine how rates of suicide and self-harm change during the course of the illness and vary according to the specific sub-type of dementia.

Cited by 148 publications

References 125 publications

Unawareness of motor phenoconversion in Huntington disease

Unawareness of motor phenoconversion in Huntington disease

Impaired Executive Function in Contemplated and Attempted Suicide in Late Life

Suicidal Behavior in Prodromal Huntington Disease

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